Publications & Presentations

"Health Reform and the Consolidation of the Healthcare Industry. What Does it Mean for Quality?" Center for Improvement in Healthcare Quality, 2012 Accredidation & Quality Summit, Orange, CA, June 7, 2012

"The Consolidation of the Health Care Industry--Why ACO's are just a piece of the puzzle." Southern Medical Association, Medico-Legal Aspects of Healthcare Emerging Policy Issues in Conjunction with Auburn University's Physician Executive MBA Program, Washington, D.C., March 21, 2012

"The Changing Dynamics of Healthcare Finance and Delivery" Presentation to Texas Association of Health Plans, Bastrop, TX, October 18, 2011

"Choosing Partners in a Complex Medical World – ACO’s and Other Practice Models” Presentation to Texas Medical Association, San Antonio, TX, July 12, 2011

"Choosing Partners in a Complex Medical World – ACO’s and Other Practice Models” Presentation to Texas Medical Association, Houston, TX, June 30, 2011

“Choosing Partners in a Complex Medical World – ACO’s and Other Practice Models” Presentation to Texas Medical Association, Dallas, TX, June 29, 2011

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June 25, 2012

I took a nice long bicycle ride around the District of Columbia this morning. A bicycle tour of the massive monuments around the Washington Mall is an exciting ride that harkens you back to high school civics, but in a fun way. These monuments are as much about what we believe are our finest ideals as they are about the humans they memorialize. It was uplifting as I made my way around Presidents Washington, Jefferson and Lincoln.

I was jolted back into thoughts of the present as I rode around the White House, Capitol Building and the Supreme Court. The expected Supreme Court ruling on health care this next week will create a storm of activity in all of these buildings. Today’s New York Times contains afront page story that suggests that overconfidence by Democrats had led them to underestimate the potential for a successful attack on the Health Reform Act. The story speculates about the political and legal miscalculations that might have occurred and the ramifications of these missteps. In a town like Washington, this is the story. Political power is the coin of this realm.

Just one thing—while the legal and political drama over the health care law has played out over the last 3 years, something else has been going on. The editors at the New York Times probably feel that their lead story on Sunday about the potential for embarrassment of President Obama and the Democratic Congressional leadership was important because of the election year fall out.

I suspect that a story in the Saturday edition of the Washington Post is a much more important story. The Post story is headlined "Inova, Aetna becoming allies in health-care plan". The Inova/Aetna venture is another in a series of arrangements between payors and providers that have been going on all over the country while the political and legal dance over health reform has played out. I wrote in detail about some of these transactions in my blog in a post entitled "Who is Driving the Train?" dated November 14, 2011.

In the grand scheme of things, the Post’s story is of greater importance to our country and its health care system than the political game of who wins elections. The Post story is a vignette about the control of the whole health care system. Payors who have the funds, proprietary information about providers, and momentum, are assimilating the physicians and providers under their respective tents. This is being done through multiple means as outlined in my November post.

Politicians do not have the political will to make the kinds of hard and in some instances hard-hearted decisions that are necessary to parcel out our limited health resources. Before we congratulate the health insurance industry too quickly about seizing the initiative, we should examine what this all may mean.

The rapid consolidation of the health industry has far ranging implications. The health insurance industry is working to remove itself from the risk, i.e., insurance business at the same time it is integrating itself into the health delivery side of the equation. It does not take a seer to understand that these large payors will gain a substantial health care market position as they consolidate the critical players.

Is it an unreasonable question to ask whether the next step is a single payor system? What if that system is one in which the payors take no risk of loss, receive fees from the government to supply and manage their networks of healthcare facilities and physicians? What if only the facilities and physicians are at risk for losses on care? Does such a result give the politicians the ability to ration care without taking the heat for the actions of the payors?

The politicized nature of the health reform debate suggests that government will never be able to work out a system to assure an equitable and cost-effective health system. However, I hope you will pardon my concerns about a health care system administered by large payors who have limited skin in the game. I am hopeful that I have heard the last of "too big to fail" during my lifetime. The massive consolidation now underway places too much control in the hands of the very payors who have been the target of complaints by patients, facilities and physicians about unfair practices.

They say that history is written by the victors. It makes me wonder if in the future that someone like me may be making a ride around the National Mall one fine day looking at new monuments that have been dedicated to the Presidents, not of the United States, but of a few large payors.

May 04, 2012

On April 9, HHS Secretary Kathleen Sebelius announced a proposed rule that would delay the compliance date for ICD-10 from October 1, 2013 to October 1, 2014. Comments are due to HHS no later than 5:00 pm ET on May 17.

To see the proposed rule, as published in the Federal Register, click here.

January 17, 2012

For: Businesses, state agencies, and clinical leaders to deepen their understanding of how to improve care delivery and population health while reducing growth in costs by redesigning care within a bundled payment program.

Click here for more information, including the link to join the webinar.

December 15, 2011

Section 6002 of the Affordable Care Act (also referred to as the “Physician Payments Sunshine Act”) requires public disclosure of the financial relationships between physicians and the pharmaceutical, medical device and biologics industries. The Affordable Care Act also requires the Department of Health and Human Services (HHS) to establish reporting procedures for applicable manufacturers to submit such information on an annual basis, as well as procedures for making that information available to the public. Under the law, applicable manufacturers and applicable group purchasing organizations (GPOs) must submit report certain information regarding the ownership or investment interests held by physicians or the immediate family members of physicians in such entities to HHS.

Comments regarding the Proposed Rule will be accepted until 5:00 p.m. (EST) on February 17, 2012.

Additionally, the Senate Special Committee on Aging had scheduled a hearing entitled, “Parting the Clouds: Implementing the Physician Payments Sunshine Act” for this afternoon (December 15, 2011) to discuss the implementation of the law. However, following the release of the Proposed Rule, the Chairman of the Committee released a statement announcing the Committee’s plan to review the Proposed Rule and reschedule the hearing for early next year.